Basic Information
| Provider Information | |||||||||
| NPI: | 1871500769 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | INDIANHEAD MEDICAL CENTER SHELL LAKE INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 300 | ||||||||
| Address2: | 113 4TH AVENUE | ||||||||
| City: | SHELL LAKE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 54871 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7154687833 | ||||||||
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| Practice Location | |||||||||
| Address1: | 113 4TH AVENUE | ||||||||
| Address2: | |||||||||
| City: | SHELL LAKE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 54871 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7154687833 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/02/2006 | ||||||||
| LastUpdateDate: | 01/14/2016 | ||||||||
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| AuthorizedOfficialLastName: | MCBEE | ||||||||
| AuthorizedOfficialFirstName: | HAROLD | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 4106433393 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 275N00000X | 1047 | WI | Y | Hospital Units | Medicare Defined Swing Bed Unit |
No ID Information.